It seems that no one ever wants to talk about this.
Some sigh, others even roll their eyes.
No juicy catharsis, no shocking revelations await.
Everyone knows, everyone has heard it a million times.
It is as boring as piano practice on a sunny afternoon.

…know how to choose and cook food that you enjoy and that meets your personal digestive and nutritional needs?

…have a clear sense of your income and expenses?

…see your medical/alternative care providers regularly?

…spend sufficient time in daylight?

…overuse, abuse, or addictively depend on toxic substances – even the “regular” ones?

…participate in meaningful recreational, social, educational, or community building activities?

You may think my inquiry is annoying and overwhelming and off the point. You may think that the behaviors I’m asking about are not really necessary and that you can get along just fine without them – because the real problem is your job, your boss, your roommate, your girlfriend, your kids, your schedule, the city you live in.

You may think that it is shockingly obvious and that, of course, you read the magazines, and the Health section in the Times, and we all know what we “should” be doing to “take care” of ourselves – but that doesn’t mean that you have the time, the structure, the wherewithal, the money, the discipline, or the motivation to do it.

I know that you believe that you should be able to feel better even while you suspect that you are living in a state of active neglect/abuse of yourself. I know that you think if I would just join you and focus on the “real problem” that you will be able to face these “other things” when you feel better, or when you win the lotto, or when you retire.

This is the real problem.

Any animal who is deprived of sleep, and/or fed inadequate nutrition, sitting in its own waste, ingesting poisons, prohibited from gross motor discharge, cut off from meaningful interaction with others of its species, experiencing unrelenting stress with no respite – all of its natural drives thwarted – is going to feel like shit. We would expect it to suffer. We anonymously call animal control on the neighbors, or feel impelled to donate money to animal rescue associations after seeing animals in such states of neglect and abuse.

It astounds me how often people prefer to first consider anti-depressant and anti-anxiety medication for clearly mild symptoms before they will consider walking to work, turning off the crappy late night TV to get to sleep earlier, cooking at home, or reducing their “normal” alcohol consumption.

There is ample and sound research that such self-care: the endorphins generated by exercise, the impact of mindfulness meditation on anxiety and pain levels etc., etc., all have substantial and measurable effects toward helping us “feel better” in the here and now. I’m not going to even bother to cite the studies.

And although coming to therapy is a significant and important step, therapy is unlikely to offer much sustainable solace if it is the only hour or two out of your week that you actually tend to yourself.

True, facing down these lifestyle changes won’t cure your bad marriage, a crazy abusive boss, your controlling father, your financial anxieties, or loneliness. It’s not going to take away all of the discomfort or pain.

But nonetheless: these activities of healthy daily living are also profoundly important symbolic gestures:

They are the daily rituals of self-regard. Actions which demonstrate that you value and will be loyal to your own core needs regardless of your mood or whim. Proof to your psyche that you will not be distracted, that you will faithfully show up for yourself. A message to the back of your brain that you will be steadfast and brave and true, that you can be trusted and reliable – and that you won’t let yourself down. These are gestures which create a symbolic experience of the devoted, attentive, reassuring internal parent who will care for you no matter what. It means committing to (at least) beginning to behave in a loving way toward yourself, even if you don’t always feel it.

As old Freud himself stated: “The ego is first and foremost a body ego.” Our first and most primal experiences of ourselves and our loved ones are through our bodies. Our essential sense of self is formed through how our bodies’ needs have been cared for – or not. Our sensory embodied experience is how we first know what it means to feel loved, valued, soothed, fed, and tended to.

Part of the function of therapy is to initiate you into the mysteries of becoming your own Healer, your own best Caretaker.

Yet, these first stages of initiation are so obvious, such a part of our common knowledge, that we often think we can forgo them altogether.
You can’t.
It will thwart your progress.

I’m not asking you to do it all at once.

I expect it to take time – there are likely years ahead of trial and error, dead-ends, stall-outs and do-over’s. You can feel lost, overwhelmed, and you can fail and quit, and regroup.

But we have to begin to listen to the nagging, pressing voice of our most basic needs – even if it feels as obvious, repetitive, and annoying as a good-enough mother reminding a child to eat their vegetables, clean their room, and practice the piano.

My therapist has me working on something similar to this. Every day I have to write in a journal as many “good for me, today I……”as I can. It’s actually a really hard exercise and I sometimes I can’t come up with any, especially on the really bad days, but it does help me to recognize that there are a lot of positives in day-to-day life. Although it may be hard to find them sometimes, they’re there!

Thanks for your comments Marla,
I do think many clients struggle with shame when we stumble upon or uncover pockets of self-neglect – and that, just as all of us do when we feel abandoned in some area of our lives, they fear that they have been uncared for – by themselves – and by others – because the state of need itself is “too much” “too needy” too vulnerable, too devouring, too ugly – to ever be responded to. I am working on a piece now – about working through the unconscious roots of this shame, that may be easier for you to share with your client. I think when therapists avoid these areas in therapy – we are in danger of colluding with this shame, and enacting neglectful patterns of care. Our real, non-judgmental interest and respect for the clients embodied need for sleep, feeding, exercise, meditation/contemplation, can become the seed of a nuturing introject – that attends and appreciates their own needs.
Best, and thank you!

it’s true what you wrote martha, that there are many basic things we can all do to take better care of ourselves. i discuss self-care with some clients even though my approach is much more psychoanalytic than behavioral too. as you said, sometimes the journey starts through an open window, not always a door. as you noted though, our self-care (or lack there of) has legs that stem from our unconscious and internal parent. while reading, i thought i might like to share this post with a particular client. i’ll have to give it some more thought for a variety of reasons. one concern with behavioral interventions/”advice” is that i worry the client will feel judged and criticized. if they could just snap out of it (or snap to it – a workout perhaps), they would. but, i do think psycho-education re self-care has a place in our work. thanks for sharing your insightful thoughts on this topic.

Middle-aged folks still roll their eyes too!
Taking on responsibility for your own parenting takes a life-time! I only in the past 3 weeks figured out a zippy-system so that I don’t have to stop, and set my bags on the ground, and frantically search for my metro-card whenever I get to the subway turnstile. And it only took me only 25 years of city-living & train-missing-aggravation to pay attention to that need!
You are terrific writer Joy, and prolific – you don’t need my inspiration – but it was lovely to read about the role that work plays in your life & in your advocacy work.
We’ll spur each other onward!
M.

i call this the “mama list”…having mostly young adults in my work, they roll their eyes when i ask them these questions.
i love your writing and it has inspired my words too. can you hear a bit of you in my recent posting? thank you so much.

Thanks John,
I think, in many ways, depth psychologists and those psychodynamically minded often feel that focus on day to day wellness and self-care is more rightly the purview of the behavior therapies – but although daily self-neglect is often an extension of deeper conflicts – attuned self-care, deep self-parenting, can create one of the most powerful corrective emotional experiences. There are resistances to change always – but if you cant get in through the cellar door – sometimes its possible to get in through the kitchen window. 😉
Thanks so much for your comments and for your readership. (is that a word? readership?)

Martha

John Lee, LCSWSeptember 29, 2011 @ 12:23 am

I agree, even when self care is not the focus, we always come back to it, adults and young children often don’t drink enough water, eat balanced nutritious meals, get fresh air, or physical activity.

i think the idea of promoting healthy balanced life should be brought up more in tx.

its very true – and I think the key to those resistances, as always, require deep, symbolic examination. Self-neglect is itself a repetition of something unconscious- albeit one that some clients are less interested in exploring. As a culture, we brush it off as laziness, as disorganization, as lack of willpower. But I belive those are all insufficient, and unempathic ways of viewing our disconnection from ourselves.
More to come – its not all quite organized yet, but this is the first part of a two or three part piece- thanks for the stimulating question! I’ll incorporate it!